Breuer, O., Shoseyov, D., Kerem, E., & Brooks , R. (2015). Implementation of a Policy Change: Replacement of Nebulizers by Spacers for the Treatment of Asthma in Children. Israel Medical Association Journal, 421-424.
Abstract
This article claims that a spacer paired with metered dose inhalers is as effective in treating asthma as nebulizers. A spacer is an “add-on” to an inhaler that makes it easier for a patient to use an inhaler. It is a tube between the end of the inhaler canister and patients mouth so that the patient does not have to have a precise breathing technique in order to effectively use their inhaler. Spacers are much cheaper than nebulizers but nebulizers remain the popular product. The study was conducted at a university medical center inside the emergency department and the pediatric ward. After 3 years of using spacers combined with MDI’s instead of nebulizers, the hospital saw a cost reduction of 63%.
Authors
Oded Breuer MD
Dr. Breuer works in the department of pediatrics as a physician at Hadassah Medical Center in Israel. Interests include asthma, cystic fibrosis, primary ciliary dyskinesia, lung diseases, and congenital malformation in airways.
David Shoseyov MD
Dr. Shoseyov works in the department of pediatrics as a physician as well as a counselor in pediatric pulmonology. He is also the head of the consultant medical committee in the Israeli Cystic fibrosis organization.
Rebecca Brooks MD
Dr. Brooks works at Hadassah Medical Center
Eitan Kerem MD
Dr. Kerem works as the head of the pediatrics division at Hadassah Medical Center. He specializes in pediatrics and sub specializes in pediatric pulmonology.
All of the authors have over publications relating to pediatric pulmonology, asthma, etc.
What are the main findings or arguments presented in the article or report?
Nebulizers can be replaced by MDI’s paired with spacers for cost effectiveness; however, the “nebulizer culture/habit” must be overcome through policy change with the help of hospital staff, patients, and their families.
Describe at least three ways that the argument is supported “All 236 [hospitalized children] were initially seen in the PED. Of those, 205 (87%) were treated with MDI+S. After transfer to the pediatric wards, the number of patients receiving salbutamol by spacers increased to 230 (97.5%). For 27 of the 31 patients treated with nebulizers in the PED, inhalers were changed to MDI+S on arrival to the wards. Four patients (1.7%) continued nebulizer treatment in the pediatric ward following the parents’ request. Two patients (0.8%) on the pediatric wards who were not satisfied with the MDI+S treatment were switched to nebulizers. “
What three (or more) quotes capture the message of the article or report?
“The MDI+S is a portable, time-saving, easy-to-use and efficient device, which helped convince most patients and personnel to switch to the new technique”
“In the case presented here, the “nebulizer culture” was considered to be the main obstacle for changing to the MDI+S device, a method proven for over two decades to be as effective if not better than the nebulizer technique.”
“A full change of practice is cost effective and may significantly reduce hospital expenses for treating asthma.”
What were the methods, tools and/or data used to produce the claims or arguments made in the article or report?
Patients were provided with an MDI+S for personal use during their hospital stay as well as oral and written instructions on how to use it.
All medical staff was required to attend a training session on the device.
Rounds were made by doctors to ensure that patients were using the device correctly for the first 6 weeks of implementation.
MDI+S cost estimation included cost of medication, device, and administration time for the nurses.
One year after MDI+S were the standard asthma device in the hospital, the policy was evaluated.
How (if at all) are health disparities or other equity issues addressed in the article or report?
Health disparities/equity issues were not addressed in this article.
Breuer, O., Shoseyov, D., Kerem, E., & Brooks , R. (2015). Implementation of a Policy Change: Replacement of Nebulizers by Spacers for the Treatment of Asthma in Children. Israel Medical Association Journal, 421-424.
Abstract
This article claims that a spacer paired with metered dose inhalers is as effective in treating asthma as nebulizers. A spacer is an “add-on” to an inhaler that makes it easier for a patient to use an inhaler. It is a tube between the end of the inhaler canister and patients mouth so that the patient does not have to have a precise breathing technique in order to effectively use their inhaler. Spacers are much cheaper than nebulizers but nebulizers remain the popular product. The study was conducted at a university medical center inside the emergency department and the pediatric ward. After 3 years of using spacers combined with MDI’s instead of nebulizers, the hospital saw a cost reduction of 63%.
Authors
Oded Breuer MD
- Dr. Breuer works in the department of pediatrics as a physician at Hadassah Medical Center in Israel. Interests include asthma, cystic fibrosis, primary ciliary dyskinesia, lung diseases, and congenital malformation in airways.
David Shoseyov MD- Dr. Shoseyov works in the department of pediatrics as a physician as well as a counselor in pediatric pulmonology. He is also the head of the consultant medical committee in the Israeli Cystic fibrosis organization.
Rebecca Brooks MD- Dr. Brooks works at Hadassah Medical Center
Eitan Kerem MD- Dr. Kerem works as the head of the pediatrics division at Hadassah Medical Center. He specializes in pediatrics and sub specializes in pediatric pulmonology.
All of the authors have over publications relating to pediatric pulmonology, asthma, etc.What are the main findings or arguments presented in the article or report?
Nebulizers can be replaced by MDI’s paired with spacers for cost effectiveness; however, the “nebulizer culture/habit” must be overcome through policy change with the help of hospital staff, patients, and their families.
Describe at least three ways that the argument is supported
“All 236 [hospitalized children] were initially seen in the PED. Of those, 205 (87%) were treated with MDI+S. After transfer to the pediatric wards, the number of patients receiving salbutamol by spacers increased to 230 (97.5%). For 27 of the 31 patients treated with nebulizers in the PED, inhalers were changed to MDI+S on arrival to the wards. Four patients (1.7%) continued nebulizer treatment in the pediatric ward following the parents’ request. Two patients (0.8%) on the pediatric wards who were not satisfied with the MDI+S treatment were switched to nebulizers. “
What three (or more) quotes capture the message of the article or report?
“The MDI+S is a portable, time-saving, easy-to-use and efficient device, which helped convince most patients and personnel to switch to the new technique”
“In the case presented here, the “nebulizer culture” was considered to be the main obstacle for changing to the MDI+S device, a method proven for over two decades to be as effective if not better than the nebulizer technique.”
“A full change of practice is cost effective and may significantly reduce hospital expenses for treating asthma.”
What were the methods, tools and/or data used to produce the claims or arguments made in the article or report?
- Patients were provided with an MDI+S for personal use during their hospital stay as well as oral and written instructions on how to use it.
- Rounds were made by doctors to ensure that patients were using the device correctly for the first 6 weeks of implementation.
- MDI+S cost estimation included cost of medication, device, and administration time for the nurses.
- One year after MDI+S were the standard asthma device in the hospital, the policy was evaluated.
How (if at all) are health disparities or other equity issues addressed in the article or report?All medical staff was required to attend a training session on the device.
Health disparities/equity issues were not addressed in this article.
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